BUDGET 2012-13 AND THE INDIAN HEALTH SECTOR

The challenge posed by the rising cost of health care in India, is accepted at all levels.  Non other than the Prime Minister Dr.Manmohan Sigh said the impact of high medical costs placed an unconscionable burden on the poor.  Speaking at a health summit, he said : “We are therefore, focusing our attention on social security of the poor with regard to their health care.”

It does not require mention that the health status of India’s people is poor.  There  are economic social and regional differences but the larger picture is one of high mortality(of infants, children and mothers), low life expectancy and  high morbidity.  The limited volume and quality of public services has been driving people to private health services.  These are booming, but the large out of pocket expenses on health care and drugs are imposing a heavy burden on patients.  Such expenditure is estimated to push 30 million people a year into poverty.

Dr. B Ekbal public health activist, author and former Vice Chancellor of  Kerala University says : “Cost of treatment has been increasing alarmingly as a result of the entry of super  and multi-specialty hospitals. Lack of government intervention has led  many private hospitals to do anything to make profits in the name of check ups or supply of medicines.”

In the context of neoliberal policies, the growth of the private medical sector in India has not been based on any planned attempt to address health needs.  Being ‘private’ by definition the sector has to function in accordance with the logic of the market.  The market(for all goods and services)does not, in the long term, allow the survival of the ‘inefficient’ entrepreneur.  In the medical sector the efficient entrepreneur is not necessarily one who provides the best service, but often the one whose profit margins are the healthiest. 

 

The logic of the market, in the medical care sector has produced a situation where now huge corporate chains are replacing smaller players. It has brought in its wake more centralization of services and  a higher degree of pooling  of skills and expertise in a few centers.   This goes against the established tenets of public health and primary health care, where it is understood that better health outcome is a function of a wide spread  of facilities and care providers, across the entire population. 

While the services of specialists and even super-specialists are underutilized in urban areas, the deficit of specialists is as high as 80 per cent or more in the public health system, especially in rural areas. On the other hand, we subsidise the medical care needs of countries in Europe and North America by exporting trained physicians, most of whom are trained at public cost.

The rapidly growing industry of medical tourism in India, now harness highly trained Indian medical professionals to treat rich medical tourist from developed nations.  While our public health system remains grossly understaffed, we do not train an adequate number of other health workers.

In this context, experts who analysed the social sector components of the Union Budget 2012-13 concluded that “the budget has failed to provide a vision or a clear direction on the policy front as far as the social sector is concerned.”( Business Standard 19.03.2012). On the healthcare, Finance Minister Pranab Mukheerji announced only an incremental  increase of about Rs.2700 crores in the allocation for the National Rural Health Mission.

The 12^th Five Year Plan envisages that the government’s health care spend will from 1.90 per cent to 2.50 per cent of GDP.  A large part of this would be under public-private partnerships(PPP). The High Level Expert Group of the Planning Commission on Universal Health Coverage for India has laid out a clear road map. The expert group chaired by Dr.K.Srinath Reddy proposed a far-going reform in several areas.  On funding, it put the onus on the government to mobilize the resources necessary  from taxation. The recommendations of the expert group, including the emphasis on making essential medicines available free to patients through state funding,  is timely. 

A book titled “Morbid System—Health Under Capitalism” edited by Leo Panitch and Collin Leys, convey the message that mindless privatization of the health care delivery system in various countries, which is the  result of neoliberal globalization is counter-productive to achieving a reasonable level of health.

Consistently low levels of public health expenditure explain the slow progress in addressing the challenges of Infant Mortality Rate(IMR), Maternal Mortality Rate(MMR) and other key health indicators.   The Out of Pocket(OOP) expense on health care at 75 per cent is one of the highest in the world and it is imperative for the State sending in health care to rise in order to alleviate the burden on the economically weaker sections of the society.

The Rashtriya Swasthya Bima Yojana(RSBY) the health care scheme meant for the Below Poverty Line(BPL), now being extended to the above poverty line section, provides Rs.30000 per family to cover treatment charges.  Several States have evolved their own distinctive health insurance schemes. Though RSBY received no mention in this year’s budget, it has seen a 45 per cent increase in allocation. On the whole, the Budget provides a marginal boost to the health sector.